Sleep is an essential biological reset, but our need for it changes throughout the lifespan, with our requirements dropping as we grow older. But what about how men and women experience sleep?
Emerging research is showing there are sex differences in sleep patterns and sleep problems. Although the causes aren't fully clear, hormones, social factors and gender roles all appear to play a part.
A 2024 review of 150 studies shows several key variations, including that women seem to have a greater need for shut-eye, sleeping more than men.
They also spend around eight minutes longer in non-REM sleep – or the deep sleep where brain activity slows right down.
But women are also nearly twice as likely to report insomnia and experience more restless leg syndrome, a condition that causes a strong urge to move the legs at night, than men.
Despite this, when doctors measure sleep patterns with sensors, women generally display better sleep quality than men.
Men, however, are more likely to suffer from obstructive sleep apnoea, a serious medical condition where the throat muscles relax and block the airway during sleep.
Is it all about hormones?
Children of both sexes seem to have similar sleep patterns, but with the surge of oestrogen, progesterone and testosterone at puberty, sleep differences emerge, and across the lifespan, women are twice as likely to say they're experiencing insomnia than men.
Hormonal shifts during puberty, menstruation, use of hormonal contraception, pregnancy and menopause all have effects on women's sleep.
For men though, levels of testosterone fluctuate across the day, and slowly decrease with time and age, having less impact on their slumber.
As men age, they experience andropause – or the male menopause – when their testosterone levels fall, which is associated with poor sleep as well.
Many women notice changes in their sleep patterns during their menstrual cycle. A drop in progesterone and oestrogen at the end of the second half can contribute to difficulty falling asleep and maintaining sleep, especially for those with premenstrual symptoms.
Hormonal shifts of pregnancy bring with it a textbook of sleep issues, starting with feeling abnormally sleepy, called hypersomnia, through to periods of insomnia and restless leg syndrome. There's also gestational obstructive sleep apnoea, which develops only during pregnancy, while the physical discomfort, anxiety around childbirth and waking for frequent toilet trips also impact sleep.
Menopause is another period where sleep is profoundly affected, with up to 70% of women reporting disturbances in their slumber. The steep drop in oestrogen leads to night sweats, hot flushes, and frequent awakenings. These symptoms not only disrupt sleep but also reduce sleep efficiency - which is the percentage of time spent asleep while in bed.
Men on the other hand, experience fluctuations of testosterone on an hourly basis, making it less impactful on sleep issues. They still have issues when testosterone levels are too low, called hypogonadal syndrome, which can affect sleep. As men age, they experience andropause – or the male menopause – when their testosterone levels fall, which is associated with poor sleep as well.
It's not only biology playing a role in sleep issues. Research also shows that women in general experience a higher mental burden relating to balancing household tasks, work and what society expects from them.
These roles can lead to higher stress levels, which may, in turn, affect their sleep quality.
Women are also more likely than men to experience conditions like anxiety and depression, which are closely linked to sleep disorders such as insomnia.
And how women perceive their sleep is influenced by factors more commonly seen in women, such as anxiety and depressed mood.
Why more research is needed in women
As in many areas of medicine, women have been understudied in sleep disorders but treatments and interventions do need to be tailored. For example, women's metabolisms are slower and so medications can tend to have more side effects in women than men, so doses need to be adjusted.
But for both sexes, one common piece of advice applies: If you feel you're having problems with your sleep, see your GP and seek advice on ways to improve it. Restorative sleep is too important to our health and wellbeing to ignore.
Dr Aurore Perrault is a postdoctoral researcher with the Sleep and Circadian Group at the Woolcock Institute of Medical Research and a Conjoint Lecturer at Macquarie University.
